This is Steven Salzberg's blog on genomics, pseudoscience, medical breakthroughs, higher education, and other topics, including skepticism about unscientific medical practices. Here's where I can say what I really think about abuses and distortions of science, wherever I see them.

Fake acupuncture works as well as "real" acupuncture

I haven't looked at acupuncture in this space yet, but a recent study in the Archives of Internal Medicine provides some entertainment - and food for thought. The authors, Brinkhaus et al., compared the treatment of lower back pain with "real" acupuncture to two alternatives: "sham" acupuncture, in which needles are placed in random locations and inserted only superficially (not as deep), and no acupuncture at all.

The study found that both sets of patients with acupuncture reported reduced lower back pain as compared to the "no treatment" group; however, there was no difference between the real and sham treatment groups. In other words, if you thought you were getting acupuncture, you reported less pain. The authors here look at this as a victory, of sorts (and they clearly believe in acupuncture themselves - raising questions of bias in the study). It's also worth noting that one of the authors has a clear financial interest in a positive outcome - he receives fees for teaching acupuncture to professional societies; and several of the authors work at centers for complementary medicine.

I'm not surprised that the sham treatment worked as well as the "real" acupuncture. However, I don't believe that either treatment really works. As with many studies of pseudoscience, the condition (here, lower back pain) is subjective and very difficult to measure. The placebo effect is obviously at work: the patients know they had a treatment, which was a painful one, and they want to believe it was worth it. A better study would have included controls who received another treatment - massage for example - rather than nothing.

Worse yet, this study is riddled with other methodological problems. First, the physicians weren't "blinded" to the treatments. In other words, the physicians knew that they were giving real vs. sham acupuncture, introducing another source of bias. A questionnaire given to patients revealed that at least some of them figured out that they had had sham treatment.

Acupuncture has been studied countless times before (sometimes with funding from our friends at NCCAM), and the best studies show, unsurprisingly to me, that it just doesn't work. (Not surprising because there is no known physiological mechanism that would allow it to work. It's just magical thinking.) Now, although meta-analyses are highly problematic themselves, the best meta-analyses are usually the Cochrane studies, so I'll mention here that there was a Cochrane study of precisely this: "The effectiveness of acupuncture in the management of acute and chronic low back pain." You can read the abstract here. They found, after reviewing many other studies, that "there was no evidence showing acupuncture to be more effective than no treatment"; in other words, it just doesn't work.

I was interested to see that Brinkhaus et al. mentioned the Cochrane study above, but dismissed it and said that more recent studies supported their opinion that acupuncture (sham or real) is better than no treatment at all. They cited a more recent (2005) Cochrane study as one of these. But ironically (or should I say "blindly" on the part of Brinkhaus et al.?) this new study did not find evidence that acupuncture works at all. The newer Cochrane study found that almost all the studies were of low quality, and that "the data do not allow firm conclusions about the effectiveness of acupuncture for acute low-back pain." But that didn't stop Brinkhaus et al. from asserting that there is an effect. As long as they study hard-to-measure phenomena like pain, with poorly designed experiments, they'll continue to be able to find weak effects and then claim that "more research is needed."

So, if you want to enrich your local alternative healer, by all means let him stick you full of needles. But if you want to feel better, there are much more pleasant choices that won't cost you a thing.